Complicated Chemicals Seek Some Corporate Lovin'

Thanks to my first post on organ donations and executions, the stories generated by my news algorithm have taken on a capital-punishment-y nature. Thus I was first alerted to the problem with Sodium thiopental, one of the three drugs used in executions (the other two are Pancuronium bromide and Potassium chloride). Hospira was apparently the only company in America that produced the drug and when they stopped production in 2009, various states turned to a London based company.

Apparently the drugs produced by that company, Dream Pharma, are of  questionable quality and legality, prompting the DEA to size various states' sodium thiopental supplies and delaying executions across the country. My home state, Georgia, was first to be investigated, followed by Tennessee and Kentucky because they apparently bought from Georgia's supply. Other states are either giving up their supply to the DEA or switching their drug cocktail (which can cause its own problems).

Depending on your views on capital punishment, you may think this shortage is a good thing. But it's indicative of a larger, troubling trend of drug shortages because cost of production exceeds profits. If you live in Alabama, Arizona, Louisiana, Texas, or any of the other states that the coral snake is found in, be extra careful. The last vial of anti-venom expired in October of 2010 with no signs of a replacement source appearing anytime soon. Occasionally, the problem is with a shaky supply chain. For instance, Arizona ran out of scorpion anti-venom because only Marilyn Bloom was producing it and she retired. But by far, the most common culprit is economics. There are maybe 100 coral snake bites a year that require the anti-venom, so the cure was never destined to be a big money maker. But now that Wyeth has stopped production completely, any company looking to be the new source has to pay and pass the multi-million dollar hurdles involved with getting a drug past the FDA approval process. But why would any company do that if it has been clearly proven that this product has no chance of ever being profitable?

This begs the question: Who should be responsible for producing things that are not profitable, yet are still necessary? The first thought that springs to mind is that the government should subsidize it, like they do for mass transit, parks, museums, and other infrastructure and amenities. However, if the government did pay to manufacture anti-venom or other unprofitable but necessary drugs, it would cross a line that would be difficult to re-draw. Would the government limit itself to just production of already known drugs or would it also take on the extremely expensive task of searching for new ones? Would it only produce drugs with expired patents or would it be allowed to ignore patents completely if there isn't a profit to be had and essentially become rogue generic manufacturer? Why would drug companies, the so called "Big Pharma," continue to chase after those ever increasingly more expensive cures if there is some other source that can constantly afford a loss? Except (currently policies notwithstanding) the government can't operate at a loss indefinitely and eventually the whole structure will come crashing down.

So. We need to come up with a solution. Ideas? For now the most effective thing I can think of is avoiding anything that might be venomous and rare. If that fails, kill it with fire. Long term outlooks on this strategy are not so good, so other suggesting are eagerly welcome.

One last note on sodium thiopental. The shortage is occurring because Hospira and many other companies that manufacture the drug are facing boycotts from European governments that belong to the EU. As the EU is opposed to execution, member countries refuse to buy from those companies unless the company can ensure that none of its drugs will be used in lethal injections. However, states have mostly side-stepped this issue by using other barbiturates, and sodium thiopental has other uses. In fact, it is listed in the WHO's list of essential medicines, meaning that it is needed for a basic health care system. I hope that no one has been adversely affected because of this shortage.

NOTE: This post DOES NOT mean that I am for or against capital punishment. It merely means that I am interested in the economics of drug design. 

Should Convicted Criminals be Executed by Vivisection?

Note: This is a re-post from my old blog as part of my migration to the Blogger platform. 

Ignore for a moment any of the bigger debates about capital punishment or the American prison system or the organ transplant system. Complete harvesting of the organs after death can save over a hundred lives. Should convicted criminals be allowed to donate their vital organs after execution?

What if there was one more path to this choice? 

One such resident of the state of Oregon argues just that in this New York Times Op-Ed. Christian Longo, convicted of murdering his wife and three children eight years ago, claims that he was inspired by Will Smith's movie Seven Pounds to offer his organs up to needed recipients after his upcoming execution. His request was denied.

This is much messier and complicated than I initially suspected when starting research for this entry. Longo is now attempting to start a nationwide program called "Gifts of Anatomical Value from Everyone" to encourage other felons on death row to attempt to donate their organs among accusations that this is just another delaying tactic to put off his own execution (at time of posting I could not find a scheduled date for that event). There is also a suspiciously beneficial relationship between Longo and NYT writer Michael Finkle (whom Longo posed as while on the run), resulting in numerous story, book, and television deals for the both of them. But all of that should have no effect on the underlying idea of organ donation, which I believe to be a good one.

GOOD Infographic. 

Every year, 6,570 people die waiting for an essential organ like heart, lungs, kidney, or liver. Around 105,000 people hover on the transplant list but only 38% of licensed drivers are organ donors (note that you do not need a driver's license to be an organ donor. You don't even need to be 18). The number is heartbreakingly low for a lot of reasons, including the mistaken belief that a doctor will not work as hard to save the life of an organ donor (52% believed). Also, if donors don't make their wishes explicit to their families, those grief-stricken families may end up revoking the donation when actually confronted with the necessary paperwork. Occasionally a donation must be denied from people with HIV, actively spreading brain cancer, and severe infections like Hepatitis, but there is no law or regulation against donation from a specific group (like criminals). So why is it not an option?

Take a closer look. 

Technically, it sort of is. The Federal Bureau of Prisons has a policy that allows deceased donation by federal inmates, though details about  actual participation of this program is slim.  Convicted inmates are allowed as individuals to appeal to their state prison boards to be able to donate an organ like a kidney to a sibling or close relative (known as a directed donation). These requests are not always granted, however, and they are sometimes granted for what some might consider the wrong reason. The case of two sisters from Mississippi who were released from jail because one sister agreed to donate her kidney to the other sister recently caught national attention. The governor agreed to suspend their sentences in exchange for the donation which relieves the state of Mississippi of the burden of paying $200,000 a year for dialysis treatments. It's always about money.

Those against the undirected donations (donation given anonymously after death) by criminals talk about the prohibitive cost of the transplant and the expenses involved in testing organs to ensure their viability. Yet consider dialysis, the treatment responsible for prolonging the life of people with chronic kidney failure, which cost the United States $8.6 billion in Medicare expenses in 2007 (because anyone, regardless of age or class, qualifies for Medicare funded dialysis treatments if they have chronic kidney failure). The financial burden on society and the emotional and physical burden on a single patient on dialysis treatments decreases significantly with a single transplant.

The other money issue is the question of compensation for organs. Should people be paid for directed donations, much in the way that an egg or sperm donor is paid? Public opinion on this issue has waxed and wanned in a continuous cycle for almost as long as organ donation has been around (click here for an interesting take on the proposal by the guys behind Freakonomics). The concern with inmates is that the compensation might take the form of shortened sentences instead of money. The best rebuttal to this issue is simply the promise that there would be no compensation. Every day ordinary citizens decide to become organ donors without any promise of compensation and so it would be with death row inmates. It is a personal choice that would need to be accompanied by the standard donation counseling and the understanding that nothing is to be gained by this selfless act (check out the Indiana University for Bioethics's fantastic page that lists multiple arguments and articles for issues and resolutions proposed on both sides).

The biggest issue stopping organ donation is the current methods of execution. Electrocution fries the organs beyond use and the cocktail of three-drugs most commonly used in most lethal injections poisons the entire body so that nearly every part is useless. Longo has apparently consulted with a doctor on the subject and reports that a single drug injection would be enough to kill without rendering the organs useless. Perhaps.

I discovered the simpler solution about two years ago when I saw the video posted below. If nothing else, make sure to watch this fantastic, powerful little short.

It's true that adding death row inmates to the voluntary donation pool will not fix the large and pressing shortage of organ donations. It will probably not even make much of a dent. But to the people who do receive these organs, it will make all the difference in the world. And we as a society owe it to everyone involved to at least allow for the opportunity. A number of bills have been submitted in various states over the past twenty years or so to allow for organ donation by death row inmates. All of those bills failed.

I hope that at least some of you will consider writing your state congressman if I have inspired your interest in this matter at all.

In conclusion, I leave you with a simple comic from one of my favorite artists, Randall Munroe (of XKCD). Organ donation is great.